Invasive home mechanical ventilation (I-HMV) experience at a palliative care center

Abstract

Aim: Although palliative care has recently become widespreadin the western countries, it has not fitted on a solid base in our country yet. There is still no consensus on the admission criteria to palliative care units. There is no widely used guidelines for the management of the patients after invasive home mechanical ventilation (I-HMV). In this study, we aimed to share our one-year clinical experience about the patients who were transferred from intensive care unit (ICU) first to palliative care center then home with I-HMV. The demographic and clinical data, education and discharge processes were evaluated. Materials and Methods: The cases that used HMV used in the palliative care service between July 2016 and September 2017 were retrospectively analyzed. The anesthesiologist was the responsible physician of the palliative care center during this time period. The age, sex, primary diagnosis and comorbidity of the patients were analyzed using statistical methods. Results: Four patients (40%) were female and 6 (60%) were male, the mean age of thepatients was 47,9 ± 16,39 years. Amyotrophic Lateral Sclerosis (ALS) was seen ın 4 patients and it was the most commonly encountered indication for admission. The mean duration of stay in our palliative care unit was 19,1±7,22days. The mean hospital stay was 19,1 days; the longest hospitalization was 32 days and the shortest hospitalization was 9 days. Only 30% of the patients have chronical disease Two (20%) patients had history of hypertension (HT), one (10%) patient had chronic obstructive pulmonary disease (COPD). Conclusion: The management of the critically ill patients with well coordination of intensive care units and palliative care centers is a critical step to improve the quality of life scores for patients were on I-HMV.

Keywords

• Invasive ventilation
• Non invasive ventilation
• Palliative care

References

1. Goldstein RS, Psek JA, GortEH. Home mechanical ventilation. Demographic sand user perspectives. Chest 1995; 108: 1581-6.
2. EroğluA, Ulusoy H, ErciyesN. Mechanical venlation at home. O.M.U. Medical Journal 2003; 20: 28-31.
3. Scrinivan S, Doty SM, White TR. Frequency causes, and outcome of home ventilatorfailure. Chest 1998; 114: 1363-7.
4. Muir JF, Cuvelier A. Evaluation of candidates for long-term ventilation. Respir Care Clin North Am 2002; 8: 405-18.
5. Wallis C, Paton JY, Beaton S, Jardine E. Children on long-term ventilatory support: 10years of progress. Arch Dis Child 2011; 96: 998-1002.
6. Gowans M, Keenan HT, Bratton SL. The population prevalence of children receiving invasive home ventilation in Utah. Pediatr Pulmonol 2007; 42: 231-6.
7. Hein H, Schucher B, Magnussen H. Quality of life of various patient groups during home mechanical ventilation. Med Clin 1999; 94: 99-101.
8. KarakurtZ.Homemechanicalventilation.JournaloftheTurkishsocietyofintensivecare. 2004; 4: 145-50.

9. Amin R, Sayal P, Syed F, Chaves A, Moraes TJ, MacLusky I. Pediatric long-term home mechanical ventilation: twenty years of follow-up from one Canadian center. Pediatr Pulmonol 2014; 49: 816-24.
10. Simonds AK. Respiratory support for the severely handicapped child with neuromuscular disease: ethics and practicality. Semin Respir Crit Care Med 2007; 28: 342-54.
11. Edwards EA, O’Toole M, Wallis C. Sending children home on tracheostomy dependent ventilation: pitfall sand outcomes. Arch Dis Child 2004; 89: 251-5.